42 research outputs found
Regional differences in severe postpartum hemorrhage: A nationwide comparative study of 1.6 million deliveries
Background: The incidence of severe postpartum hemorrhage (PPH) is increasing. Regional variation may be attributed to variation in provision of care, and as such contribute to this increasing incidence. We assessed reasons for regional variation in severe PPH in the Netherlands. Methods: We used the Netherlands Perinatal Registry and the Dutch Maternal Mortality Committee to study severe PPH incidences (defined as blood loss â„ 1000 mL) across both regions and neighborhoods of cities among all deliveries between 2000 and 2008. We first calculated crude incidences. We then used logistic multilevel regression analyses, with hospital or midwife practice as second level to explore further reasons for the regional variation. Results: We analyzed 1599867 deliveries in which the incidence of severe PPH was 4.5%. Crude incidences of severe PPH varied with factor three between regions while between neighborhoods variation was even larger. We could not explain regional variation by maternal characteristics (age, parity, ethnicity, socioeconomic status), pregnancy characteristics (singleton, gestational age, birth weight, pre-eclampsia, perinatal death), medical interventions (induction of labor, mode of delivery, perineal laceration, placental removal) and health care setting. Conclusions: In a nationwide study in The Netherlands, we observed wide practice variation in PPH. This variation could not be explained by maternal characteristics, pregnancy characteristics, medical interventions or health care setting. Regional variation is either unavoidable or subsequent to regional variation of a yet unregistered variable
Search Strategy for The Benefits, Burdens, and Risks of Participation in Pediatric Palliative Care and End of Life Research: a Systematic Review
VAST: An ASKAP Survey for Variables and Slow Transients
The Australian Square Kilometre Array Pathfinder (ASKAP) will give us an
unprecedented opportunity to investigate the transient sky at radio
wavelengths. In this paper we present VAST, an ASKAP survey for Variables and
Slow Transients. VAST will exploit the wide-field survey capabilities of ASKAP
to enable the discovery and investigation of variable and transient phenomena
from the local to the cosmological, including flare stars, intermittent
pulsars, X-ray binaries, magnetars, extreme scattering events, interstellar
scintillation, radio supernovae and orphan afterglows of gamma ray bursts. In
addition, it will allow us to probe unexplored regions of parameter space where
new classes of transient sources may be detected. In this paper we review the
known radio transient and variable populations and the current results from
blind radio surveys. We outline a comprehensive program based on a multi-tiered
survey strategy to characterise the radio transient sky through detection and
monitoring of transient and variable sources on the ASKAP imaging timescales of
five seconds and greater. We also present an analysis of the expected source
populations that we will be able to detect with VAST.Comment: 29 pages, 8 figures. Submitted for publication in Pub. Astron. Soc.
Australi
Appraising the Qualities of Social Work Studentsâ Theoretical Knowledge: A Qualitative Exploration
Van Bommel, M., Boshuizen, H. P. A., & Kwakman, K. (2012). Appraising the qualities of social work students' theoretical knowledge: A qualitative exploration. Vocations and Learning, 5, 277-295. doi:10.1007/s12186-012-9078-9Higher professional education aims to prepare students for entering practice with an adequate theoretical body of knowledge. In constructivist programmes, authentic learning contexts and self-directed learning are assumed to support knowledge learning and the transition from education to practice. Through an in-depth exploration, this case study aimed at defining and assessing the qualities of social work studentsâ theoretical knowledge at initial qualification. Participants were final-year bachelorâs students (n=18) in a constructivist professional programme of social work. Studentsâ knowledge concerning a real-life practical case was elicited through an interview and a form of concept mapping. A six-step procedure was used for a qualitative appraisal of studentsâ knowledge with the assistance of seven expert teachers. During this procedure an instrument for analysing knowledge qualities was developed, comprising 13 aspects representing four features of expert knowledge: extent, depth, structure, and critical control. Results showed that 13 students received high appraisals for their knowledge extent and depth. Only 4 students received high appraisals for knowledge structure and critical control. 5 Students who received overall lower appraisals seemed inhibited to show their knowledge qualities by preoccupations with self-concerns about their own professional role. Conclusion is that the majority of students needs more learning support for knowledge structure and critical control than offered by their constructivist programme. Further research is needed into the personal factors that influence studentsâ theoretical knowledge learning and which knowledge qualities can be reached by young adults in a four year educational programme.Hogeschool Arnhem Nijmege
Europeanization and de-Europeanization in UK Employment Policy: Changing Governments and Shifting Agendas
Transcriptome Analysis of the Arabidopsis Megaspore Mother Cell Uncovers the Importance of RNA Helicases for Plant Germline Development
Germ line specification is a crucial step in the life cycle of all organisms. For sexual plant reproduction, the megaspore mother cell (MMC) is of crucial importance: it marks the first cell of the plant âgermlineâ lineage that gets committed to undergo meiosis. One of the meiotic products, the functional megaspore, subsequently gives rise to the haploid, multicellular female gametophyte that harbours the female gametes. The MMC is formed by selection and differentiation of a single somatic, sub-epidermal cell in the ovule. The transcriptional network underlying MMC specification and differentiation is largely unknown. We provide the first transcriptome analysis of an MMC using the model plant Arabidopsis thaliana with a combination of laser-assisted microdissection and microarray hybridizations. Statistical analyses identified an over-representation of translational regulation control pathways and a significant enrichment of DEAD/DEAH-box helicases in the MMC transcriptome, paralleling important features of the animal germline. Analysis of two independent T-DNA insertion lines suggests an important role of an enriched helicase, MNEME (MEM), in MMC differentiation and the restriction of the germline fate to only one cell per ovule primordium. In heterozygous mem mutants, additional enlarged MMC-like cells, which sometimes initiate female gametophyte development, were observed at higher frequencies than in the wild type. This closely resembles the phenotype of mutants affected in the small RNA and DNA-methylation pathways important for epigenetic regulation. Importantly, the mem phenotype shows features of apospory, as female gametophytes initiate from two non-sister cells in these mutants. Moreover, in mem gametophytic nuclei, both higher order chromatin structure and the distribution of LIKE HETEROCHROMATIN PROTEIN1 were affected, indicating epigenetic perturbations. In summary, the MMC transcriptome sets the stage for future functional characterization as illustrated by the identification of MEM, a novel gene involved in the restriction of germline fate
Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study
Background Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex. Methods CKD patients (>= 65 years; estimated glomerular filtration rate <= 20 mL/min/1.73 m(2)) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-item Mental Health Inventory (cut-off <= 70; 0-100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders. Results Overall kidney function decline in 1326 patients was -0.12 mL/min/1.73 m(2)/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03-1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or with the combined outcome (i.e. dialysis initiation and all-cause mortality). Conclusions There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men
A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.
The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (nâ=â21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world
Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study
Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008â11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003â13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 Ă 10â10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 Ă 10â8 DHFR p=8·37 Ă 10â7 MTRNR2L2 p=2·15 Ă 10â9) and to a lesser extent in REGISTRY (MSH3 p=9·36 Ă 10â4 DHFR p=8·45 Ă 10â4 MTRNR2L2 p=1·20 Ă 10â3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 Ă 10â8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16â0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06â0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation
Automutilations chroniques: des patient/es difficiles
Patientinnen mit chronischer SelbstbeschĂ€digung stellen eine Gruppe schwieriger Patientinnen dar, die hĂ€ufig wenig zu einer psychiatrischen oder psychotherapeutischen Behandlung motiviert sind. Nach dem Versuch einer klinischen Einteilung wird auf ein psychoanalytisches Konzept zur Psychodynamik selbstverletzenden Verhaltens eingegangen. AbschlieĂend wird das Schema der KOMEPP (Kontext orientierte Modellentwicklung bei einer Psychotherapieplanung) vorgestellt und mögliche therapeutische Probleme im Umgang mit dieser schwierigen Patientinnengruppe diskutiert.SchlĂŒsselwörter: Chronische SelbstbeschĂ€digung, Psychotherapie.atients with self mutilation behavior represent a group of difficult patients, who are often less motivated for psychiatric or psychotherapeutic treatment. After attempting a clinical classification we discuss a psychoanalytical, psychodynamic concept of self-mutilation behavior. Finally a new concept (KOMEPP) of a context oriented development of models for planning psychotherapy is presented and different psychotherapeutic problems dealing with this special group of patients are discussed.Keywords: Self-mutilation behavior, psychotherapy.Lorsquâun/e patient/e se blesse volontairement, son environnement proche a de multiples rĂ©actions Ă©motionnelles: consternation, sentiment dâimpuissance, horreur et peur.Du fait que les patient/es souffrant de sĂ©rieux troubles de la personnalitĂ© reprĂ©sentent une proportion croissante de la clientĂšle des institutions, mais aussi des cabinets de psychothĂ©rapie, la question de savoir comment gĂ©rer adĂ©quatement les Ă©volutions chroniques dans lesquelles les patients sâautomutilent gagne en importance. Avant dâaccepter de traiter ce genre de patient en ambulatoire et dans le cadre dâun cabinet privĂ©, il faut poser un diagnostic clair et dĂ©finir sans Ă©quivoque le contexte du traitement.Nous traitons ci-dessous de la maniĂšre dont une psychothĂ©rapie peut ĂȘtre planifiĂ©e en fonction de lâĂ©laboration dâun modĂšle tenant compte de son contexte. Cette approche doit permettre de prĂ©parer le traitement de patients difficiles en associant Ă sa planification leur environnement familial et psychosocial, ceci durant lâĂ©laboration du modĂšle et le projet de psychothĂ©rapie dĂ©jĂ .La maniĂšre dont Herpertz et Sass (1994) proposent de dĂ©finir lâautomutilation chronique nous semble utile: âPar automutilation chronique manifeste, on entend toutes les blessures physiques que le/la patient/e sâinflige, exception faite de celles qui visent Ă entraĂźner la mort. Le patient comme ses proches savent que câest celui-ci qui a causĂ© la blessure.â Cette dĂ©finition exclut les comportements qui ont des effets nĂ©fastes indirects (fumer, par ex.), ainsi que lâabus de nourriture ou de boissons nuisibles Ă la santĂ©.Du point de vue clinique, on effectue une distinction entre des formes relativement peu sĂ©rieuses (coupures superficielles, petites brĂ»lures, Ă©gratignures, morsures, coups sur la tĂȘte ou les extrĂ©mitĂ©s, manipulation de plaies, brĂ»lures causĂ©es par des substances alcalines ou acides, trichotilomanie, extraction dâongles etc.) et dâautres formes plus graves (ablation de lâĆil, castration, mutilation des mamelons, amputation dâune extrĂ©mitĂ©).De notre point de vue, il faut inclure dans cette catĂ©gorie diagnostique les comportements autodestructeurs qui provoquent des atteintes physiques: infection ou lĂ©sions dermiques artificielles, saignements, ainsi que les hypo- et hyperglycĂ©mies provoquĂ©es sciemment par des patients diabĂ©tiques, etc.Le service de traitement ambulatoire des automutilations chroniques Ă©tabli dans le cadre de la Clinique universitaire de psychologie des profondeurs et de psychothĂ©rapie de lâUniversitĂ© de Vienne a dĂ©veloppĂ© un schĂ©ma, sur la base duquel une psychothĂ©rapie peut ĂȘtre planifiĂ©e- la âKontextorientierte Modellentwicklung bei einer Psychotherapieplanungâ, KOMEPP (Schuster et al., 1998, en prĂ©paration). Lâutilisation de ce schĂ©ma permet souvent de crĂ©er les conditions rendant possible lâoffre dâun traitement psychothĂ©rapeutique Ă ce groupe de patients difficiles.Lors du processus menant Ă un premier entretien on tente de dĂ©finir, avec le/la patient/e, les variables qui vont favoriser le traitement. La discussion des problĂšmes se fait sur des bases multiprofessionnelles et multiĂ©coles et tente de saisir les points saillants du contexte. Ceci implique que les professionnels qui se sont dĂ©jĂ occupĂ©s du patient (mĂ©decins, assistantes sociales, psychothĂ©rapeutes) et les personnes appartenant Ă son contexte social (famille, enseignants, assistants sociaux etc.) collaborent directement Ă lâĂ©laboration dâun modĂšle de psychothĂ©rapie. Durant la phase qui prĂ©cĂšde la planification du traitement, toutes les personnes faisant partie de lâenvironnement du patient participent donc Ă la discussion, ce qui permet de prĂ©parer un modĂšle individuel de traitement.Une planification soigneuse de la psychothĂ©rapie permet ensuite dâappliquer ce modĂšle. Les patient/es souffrant de sĂ©rieux troubles de la personnalitĂ© sont souvent incapables de gĂ©rer la thĂ©rapie. Lorsque des problĂšmes se prĂ©sentent dans leur environnement social, leur famille, avec leurs enfants, etc. ce sont souvent une assistante sociale ou un mĂ©decin qui assument cette fonction. Lâunique possibilitĂ© de mener une psychothĂ©rapie avec ces patients difficiles implique frĂ©quemment que lâon confie Ă une personne 'externeâ la tĂąche de gĂ©rer le traitement, de le coordonner et de servir de 'centre de dĂ©cisionâ. Du point de vue de son contenu, nous considĂ©rons quâune thĂ©rapie dâorientation psychanalytique doit viser Ă mettre en Ă©vidence les aspects ayant une fonction psychologique qui sont contenus dans les actes dâautomutilation. Le patient qui se voyait contraint dâagir (dans un sens destructif) doit pouvoir faire lâexpĂ©rience de et verbaliser ces contenus, dĂ©couvrant leur signification dans le cadre dâune interaction avec le thĂ©rapeute. Initialement, il va sans doute refuser cette signification; mais en cours de thĂ©rapie, elle pourra ĂȘtre intĂ©grĂ©e dans lâensemble de sa personnalitĂ©. Du fait que les patient/es dont nous parlons souffrent souvent de graves troubles de la personnalitĂ©, les pronostics ne peuvent pas ĂȘtre trop optimistes - et pourtant une psychothĂ©rapie Ă long terme reprĂ©sente souvent la seule chance de traitement